Clinical predictors of donor antibody titre and correlation with recipient antibody response in a COVID-19 convalescent plasma clinical trial.

BACKGROUND: Convalescent plasma therapy for COVID-19 relies on transfer of anti-viral antibody from donors to recipients via plasma transfusion. The relationship between clinical characteristics and antibody response to COVID-19 is not well defined. We investigated predictors of convalescent antibody production and quantified recipient antibody response in a convalescent plasma therapy clinical trial. METHODS: Multivariable analysis of clinical and serological parameters in 103 confirmed COVID-19 convalescent plasma donors 28 days or more following symptom resolution was performed. Mixed-effects regression models with piecewise linear trends were used to characterize serial antibody responses in 10 convalescent plasma recipients with severe COVID-19. RESULTS: Donor antibody titres ranged from 0 to 1 : 3892 (anti-receptor binding domain (RBD)) and 0 to 1 : 3289 (anti-spike). Higher anti-RBD and anti-spike titres were associated with increased age, hospitalization for COVID-19, fever and absence of myalgia (all P < 0.05). Fatigue was significantly associated with anti-RBD (P = 0.03). In pairwise comparison amongst ABO blood types, AB donors had higher anti-RBD and anti-spike than O donors (P < 0.05). No toxicity was associated with plasma transfusion. Non-ECMO recipient anti-RBD antibody titre increased on average 31% per day during the first three days post-transfusion (P = 0.01) and anti-spike antibody titre by 40.3% (P = 0.02). CONCLUSION: Advanced age, fever, absence of myalgia, fatigue, blood type and hospitalization were associated with higher convalescent antibody titre to COVID-19. Despite variability in donor titre, 80% of convalescent plasma recipients showed significant increase in antibody levels post-transfusion. A more complete understanding of the dose-response effect of plasma transfusion amongst COVID-19-infected patients is needed.

The Effect of MHC Antigen Matching Between Donors and Recipients on Skin Tolerance of Vascularized Composite Allografts.

The emergence of skin-containing vascularized composite allografts (VCAs) has provided impetus to understand factors affecting rejection and tolerance of skin. VCA tolerance can be established in miniature swine across haploidentical MHC barriers using mixed chimerism. Because the deceased donor pool for VCAs does not permit MHC antigen matching, clinical VCAs are transplanted across varying MHC disparities. We investigated whether sharing of MHC class I or II antigens between donors and recipients influences VCA skin tolerance. Miniature swine were conditioned nonmyeloablatively and received hematopoietic stem cell transplants and VCAs across MHC class I (n = 3) or class II (n = 3) barriers. In vitro immune responsiveness was assessed, and VCA skin-resident leukocytes were characterized by flow cytometry. Stable mixed chimerism was established in all animals. MHC class II-mismatched chimeras were tolerant of VCAs. MHC class I-mismatched animals, however, rejected VCA skin, characterized by infiltration of recipient-type CD8+ lymphocytes. Systemic donor-specific nonresponsiveness was maintained, including after VCA rejection. This study shows that MHC antigen matching influences VCA skin rejection and suggests that local regulation of immune tolerance is critical in long-term acceptance of all VCA components. These results help elucidate novel mechanisms underlying skin tolerance and identify clinically relevant VCA tolerance strategies.

Biogenic acids produced on epoxy linings installed in sewer crown and tidal zones.

In this study the biogenic acids generated by microbes on the surface of Bisphenol A epoxy mortar coupons were investigated for up to 30 months. The epoxy coupons were installed in six sewers in three city locations, Sydney, Melbourne and Perth. Coupons were installed in both the crown and the tidal zones of the sewers to capture the effect of location within the pipe on acid production. The coupons were retrieved approximately every 6 months to provide a dynamic analysis of the biogenic acid production. Our results reveal the colonisation of epoxy mortar by the more aggressive acidophilic bacteria occurred within six months to two years of their installation in the sewer pipes. Biogenic acid generation appear to occur homogeneously from the tidal zone to the crown of the sewer pipes. The reduction in the surface pH of the epoxy lining was supported by the successive growth of microbes beginning with fungi followed be neutrophilic and heterotrophic bacteria and finally by the acidophilic bacteria and the corresponding accumulation of organic and sulphuric acids attributed to these organisms. This study also revealed the potential inhibiting effects on the microbes induced by the accumulation of metabolic products on the epoxy surface. The accumulation of organic acids and H2S coincided with the growth and metabolism inhibition of fungi and acidophilic bacteria. These results provide insights into the microbial interaction and biogenic acids production that contribute to lining degradation and corrosion of concrete in sewer pipes.

Undergraduate education in trauma medicine: the students' verdict on current teaching.

BACKGROUND: Junior doctors are amongst the first healthcare professionals to assess and provide initial hospital care for multiply injured patients. Despite this, no requirements are placed upon UK medical schools for training undergraduates in aspects of trauma care. Medical students have increasingly been attending a number of student-organised extracurricular 'trauma conferences' in order to supplement their knowledge in this area. AIM: To provide insight into the quality and quantity of trauma medicine teaching currently received at the undergraduate level by directly eliciting the experiences of medical students. If a perceived lack of trauma teaching is driving students to seek extracurricular exposure to trauma education, what lessons can be gleaned for medical schools? METHODS: A voluntary, anonymous, quantitative questionnaire was used to collect data from 218 medical students from across the UK. RESULTS: Among our results, 60% of final-year students were shown to have received fewer than 5 h of teaching in trauma medicine. Basic cervical-spine immobilisation teaching had not been received by 62%, while a third had not received Basic Life Support (BLS) training. The majority of students believed their training in trauma medicine not to be adequate and would like to see more teaching offered by their respective medical schools. CONCLUSION: Students report a paucity of teaching in trauma medicine. Our findings corroborate previous concerns that junior doctors are under-prepared for managing trauma patients, and support the repeated calls made in the scientific literature to include organised teaching of trauma medicine in the undergraduate curriculum.